Research Interests

Research Organizations

Research Summary

Through a series of epidemiologic and intervention studies in the area of falls and fall injury, our group identified risk factors in older persons related to falls and injuries associated with a range of serious adverse outcomes including nursing home placement and functional decline, and that multifactorial risk reduction strategies were effective and cost-effective at reducing the rate of falling. Efforts to translate these research findings into clinical and public health practice, with suggestions for prevention, are in place.

Other clinical research studies, with resulting publications, cover the areas of functional disability, mobility impairment, and the adverse effects of multiple medications. A recent area of investigation is clinical decision making in the face of multiple competing health conditions.

I direct an interdisciplinary research program in geriatrics and clinical epidemiology at the Yale School of Medicine.

Specialized Terms: Falls and injuries; Mobility; Clinical decision-making in the face of multiple health conditions; Harms and benefits of medications

Extensive Research Description

Many of the most frequent health conditions that cause morbidity and compromised functioning and quality of life among older persons result from combinations of medical, psychological, social, environmental, and other factors. The focus of my work has been on the assessment, management, and prevention of multifactorial geriatric health conditions such as falls, immobility, and dizziness. Observational studies and randomized controlled trials are conducted in various settings including the home, hospital, nursing home and outpatient clinics. The research projects are interdisciplinary including nursing, rehabilitation, epidemiology, biostatistics, medicine, and other disciplines.

Other ongoing projects include determining the contribution of multiple conditions to death; mapping disease-specific health outcomes onto a set of universal health outcomes; determining the prevalence and effects of the co-occurrence of competing health conditions; and determining the disease-specific and universal health outcomes associated with treating one disease in the face of the co-occurrence of another disease that worsens with treatment of the first disease (therapeutic competition).

Multimorbidity in older adults (Variable priorities in the face of competing outcomes: The tradeoff among cardiovascular events, medication symptoms, and fall injuries.)

Universal outcomes as a common metric across multiple diseases among elders.

Determination of whether multiple co-occurring chronic and acute conditions contributed to the deaths in two cohorts of older adults and the extent of the contribution of these conditions to the deaths.

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